A former colleague of mine, an Irish citizen, but originally from Cameroon recently received a terminal diagnosis from the Oncology team in Beaumont hospital. He was admitted for mild fever - excellent junior doc working that shift noticed jaundice in the whites of the eyes 1/5

Scans and subsequent scans suggested that he had Stage 4 cancer, and waiting for biopsy results to determine potential treatment courses. Was deemed to be too widespread for anything other than palliative 2/5

Team suggested he go home to Cameroon to see his kids and wife (who herself was finishing chemo for breast cancer) one last time. This he did and came back for discussion on treatment.
He felt fit, healthy, no weight-loss but no denying the seriousness of scan results 3/5

Biopsy came back with a bit of hope - cancer had originated in the bile duct. There could be hope of treatment, but every day mattered. Duct would need draining, very delicate procedure - was referred to St Vincent's to handle. He was buzzing with new-found hope. 4/10

And then......nothing....No Contact from St Vincents, no response to his calls. No response from the team in Beaumont. He was left in limbo with his life literally slipping away before him. He had full health insurance, so can't blame 2-tier health system. 5/10

His wife had been successfully treated at a large cancer hospital in Bangalore. He contacted them, booked a flight and he had surgery 2 days later - his bile duct successfully drained, has been on mix of treatment since and his prognosis is good. His treatment will continue 6/10

...for another 4 months. All his stats are going right direction, tumor shrinking and his is likely to have a few of more surgical procedures and rounds of chemo to close out.
The team suggest he is likely to be still around in 20 years time. 7/10

I have no doubt that the team in Vincent's could have achieved similar results. But nobody answered his calls. Either his case never got onto lists due to poor administration flows (highly likely) or clinical workload too high to enable proper case triage and prioritisation 8/10

Either way it is quite damning that in a country w/ some of the best medics in the world that someone who (a) is a citizen, (b) resident taxpayer (c) has full health insurance (which shouldn't matter but it does) should have to resort to paying $50k in India to save his life 9/10

In order to support his treatment, he has set up a gofundme page. Can I ask for people to amplify and support if possible:
https://www.gofundme.com/f/u5hvm-assistance?utm_source=whatsApp&utm_medium=chat&utm_campaign=p_cp+share-sheet

I'd like to thank everyone who has re-tweeted and amplified this, and also respond to some of the comments on this thread....

P.S. 1/ I've been around Irish healthcare for some time - since 2006 with Slainte Healthcare, which subsequently morphed into two companies, Claimsure Ireland and Vitro Software.
So I've had a close up look at how patient flows, referrals and clinical records are captured

P.S. 2/ A common theme has been the lack of attention shown to "administrative processes" as I guess there is nobody with enough of a birds-eye view to advocate for same and articulate the impact that could be made.

P.S. 3/ Contrast with clear path for improvements to a medical procedure - medics articulate clinical case, push for it (no medic wants to be performing sub-optimal procedures) - enough clinical support for new procedure or device etc and it will be adopted

P.S. 4/ Yet.... for me there is so much "unseen" clinical risk with lack of optimisation of admin processes - from appointment/theatre scheduling to handling and triaging of referrals to adopting more sophisticated patient communication (including allowing them see own record)

P.S. 5/ There are so many points of potential failure where if someone doesn't do their job well or is overcapacity, errors happen. Errors happen anyway - it is important for processes and systems to be designed to mitigate. For example if error rate is 6% (94% correct), then ...

P.S. 6/ this may be acceptable if there is one potential point of failure, and indeed in such case, a secondary review process would likely reduce error rate to 0.36% (6%*6%).
However if there are, say 5 points of failure, then error rate gets very significant. 1-(0.94)^5 = 26.7%

P.S. 7/ And in such cases, it is impossible to have secondary reviews on each potential point of failure as there are too many and the system is stretched enough as it is...

P.S. 8/ So with the processes that are in place, there is too much reliance on people being alert and attentive to not miss things. And the cold truth is that some people in the system are somewhat de-sensitized to the fact that what they do might affect someone's life...

P.S. 9/ there is always a lot of focus on clinical staff, but I've always got a sense that because of that, some admin staff feel they are just doing an admin job and don't see themselves as part of the care team - when in fact how they perform could have a massive impact

P.S. 10/ on the outcome for the patient and the overall experience for the patient's family also. It may also be a consequence of having so much thrown at them that there is a need to be desensitised otherwise your stress levels would become unsustainable.

P.S. 11/ The bigger takeaway is that without paying attention to the systems and processes that underpin patient flows and clinical information exchange, it will be impossible to improve the health system

P.S. 12/ And this then begs the question as to who will do it? It doesn't seem to be anyone's core responsibility - everyone (including potential suppliers) is focused on piecemeal solutions - no-one is incentivised or empowered to look at the overall picture

P.S. 13/ So what's left is like having lots of jigsaw pieces from lots of different jigsaws - different designs, different sizes etc, and wondering why you can't put them together in a coherent way.

P.S. 14/ Lastly I just want to acknowledge those who made point RE Alain being able to go to India. He couldn't afford it - he couldn't afford not to. He pulled enough to get flight and get seen. His company and wider circle have been supportive, & he appreciates the support here